title: Impact of early oseltamivir treatment on outcome in critically ill patients with 2009 pandemic influenza A.
abstract: OBJECTIVE
  The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A (2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between the timing of antiviral administration and intensive care unit (ICU) outcomes.
  
  
  METHODS
  Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection. Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) with oseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint. Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality.
  
  
  RESULTS
  Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients required mechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy and were included in the study group. All patients received oseltamivir for a median duration of 10 days (interquartile range 8-14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groups were comparable in terms of main clinical variables. ICU length of stay (22.7 ± 16.7 versus 18.4 ± 14.2 days; P = 0.03), hospital length of stay (34.0 ± 20.3 versus 27.2 ± 18.2 days; P = 0.001) and MV days (17.4 ± 15.2 versus 14.0 ± 12.4; P = 0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than in ET (21.5%; OR = 1.9; 95% CI 1.06-3.41). A multivariate model identified ET (OR = 0.44; 95% CI 0.21-0.87) as an independent variable associated with reduced ICU mortality. These results were confirmed by propensity score analysis (OR = 0.44; 95% CI 0.22-0.90; P < 0.001).
  
  
  CONCLUSIONS
  Our findings suggest that early oseltamivir administration was associated with favourable outcomes among critically ill ventilated patients with 2009 H1N1 virus infection.
authors.affiliation: Hospital Joan XXIII, Critical Care Department-IISPV-URV-CIBERES, Tarragona, Spain. ahr1161@yahoo.es
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Emili
authors.initials: E
authors.lastname: Díaz
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martín-Loeches
authors.forename: Alberto
authors.initials: A
authors.lastname: Sandiumenge
authors.forename: Laura
authors.initials: L
authors.lastname: Canadell
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Díaz
authors.forename: Juan C
authors.initials: JC
authors.lastname: Figueira
authors.forename: Asunción
authors.initials: A
authors.lastname: Marques
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallés
authors.forename: Bárbara
authors.initials: B
authors.lastname: Baladín
authors.forename: Fernando
authors.initials: F
authors.lastname: García-López
authors.forename: Borja
authors.initials: B
authors.lastname: Suberviola
authors.forename: Rafael
authors.initials: R
authors.lastname: Zaragoza
authors.forename: Sandra
authors.initials: S
authors.lastname: Trefler
authors.forename: Juan
authors.initials: J
authors.lastname: Bonastre
authors.forename: José
authors.initials: J
authors.lastname: Blanquer
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D016638:Critical Illness; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000008:administration & dosage*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir